Saturday, 15 January 2005 - 12:00 PM

This presentation is part of: Poster Session II

Managed care limits & social work interventions to reduce patient discharge with unmet needs

Purpose: This study documents the impact of types of social work interventions, types of client psychosocial conditions and agency auspice on the frequency of patient discharge with unmet needs in home health agencies. Home health care funding (i.e., Medicare, Medicaid or private insurance) is dominated by the managed care principle of capitated coverage. Thus, agencies may attempt to keep their costs within capitated limits by enhancing efficiency and/or by rationing services regardless of patients’ needs. Previous research findings suggest that risk for discharge with unmet needs in home health may be increased in for-profit agencies and for patients with cognitive impairment and patients with inadequate family caregivers. Design & Measurements: The research utilized a survey mailed to a systematic random sampling of social workers (N=501) in Medicare-certified home health agencies nation-wide in the winter of 2002-2003 (response rate=42%). Respondents indicated agency auspice (for-profit =1, non-profit=0), and rated the following items on Likert type scales: (a) the frequency (from rarely =1 to extremely often =4) of conflicts between social workers' assessments of patient needs and managed care limits resulting in patient discharge with unmet needs; (b) the importance to the agency (from not at all important =1 to very important=5) of each of the following four interventions: advocating for patient needs within your agency; financial planning with patients/families; linking patients with community resources; and discharge planning; and (c) how typical (from not at all typical=1 to very typical=3) each of the following four types of patient psychosocial conditions were of patients discharged with unmet needs: cognitive impairment; no personal financial resources; lives alone; and the family is unable to provide care. Results: A regression model was generated on the basis of correlation analysis with the criterion for independent variable inclusion in the regression model set at a more conservative probability level (p<.01). Multiple regression with simultaneous entry analysis found that the following independent variables, two types of social work interventions (1-financial planning for health care with patients/families and 2-advocating for patients within agencies) were significant negative predictors, and agency auspice and two types of patient needs (1-cognitive impairment and 2-inadequate family caregivers) were significant positive predictors, in a model explaining 32% of the variance in the frequency of the conflict resulting in patient discharge with unmet needs [Adj. R =.318, F(6,87)=8.224, p>.001]. Intervening by linking patients with community resources was not significant in the regression. Implications for practice: The findings suggest that patients with cognitive impairment and/or inadequate family care giving are at risk for discharge with unmet needs. Reducing patient discharge with unmet needs from home health agencies may be best achieved through advocacy within the practitioner’s agency for patients’ needed care, financial planning for health care with patients/families, and screening for patient cognitive impairment and family caregiver capacity.

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